logging in or signing up Neonatal Jaundice samarsen Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 2853 Category: Science & Tech.. License: All Rights Reserved Like it (2) Dislike it (0) Added: May 13, 2010 This Presentation is Public Favorites: 3 Presentation Description No description available. Comments Posting comment... By: KOLLKHARAH (7 month(s) ago) PLEASE SEND IT TO ME Saving..... Post Reply Close Saving..... Edit Comment Close By: ajithanair005 (19 month(s) ago) nice presentation Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Neonatal Jaundice : Neonatal Jaundice Meena Sharma ANNP Objectives : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 2 Objectives Definition Production & metabolism of bilirubin Types of jaundice Management Neonatal Hyperbilirubinemia : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 3 Neonatal Hyperbilirubinemia Occurs in up to 60% of healthy term infants Yellow discolouration of skin, sclera & mucous membrane. Clinically evident when SBR reaches 80-100 umol/l Slide 4: 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 4 Bilirubin production & metabolism : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 5 Bilirubin production & metabolism Hb in neonate =18-19g/dl and in adult =11-14g/dl Breakdown of excess RBCs (Haemoglobin is a constituent of RBC) Hb broken into: globin - a protein that is conserved and utilised haem - cannot be used degraded and excreted Bilirubin is a product of this degradation It causes yellow staining of the tissues Bilirubin production & metabolism : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 6 Bilirubin production & metabolism The bilirubin first formed is UNCONJUGATED & FAT SOLUBLE. It cannot be excreted in bile or urine Unconjugated Bilirubin - travels in plasma, bound to albumin,can cross the blood brain barrier - enters the liver cells with the aid of Y & Z carrier proteins - becomes conjugated with glucoronic acid The reaction is catalysed by an enzyme Glucuronyl Transferase Bilirubin production & metabolism : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 7 Bilirubin production & metabolism Conjugated bilirubin is further catabolised by intestinal flora into: urobilinogen stercobilin It forms a major component of bile in faeces.(This gives the characteristic yellow colour to faeces.) A small amount is passed in the urine Enterohepatic circulation Slide 8: 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 8 Types of Jaundice : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 9 Types of Jaundice Physiological- 24 hrs-2 weeks old Pathological <24 hours old Prolonged jaundice- Term >2 weeks Preterm >3 weeks Physiological Jaundice : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 10 Physiological Jaundice Usually reaches its peak level at 2-5 days of age. Increased RBC’s Shortened RBC lifespan Immature hepatic uptake & conjugation Increased enterohepatic Circulation Physiological Factors Associated with Physiological Jaundice : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 11 Physiological Factors Associated with Physiological Jaundice Hb level is higher than required RBC have shorter life Hepatic Immaturity - reduced glucuronyl transferase activity - reduced active uptake of UB - reduced intracellular transport system - reduced active secretion of CB - large enterohepatic circulation of bilirubin to add to the load of UB in the hepatocyte 24 hours-2 weeks : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 12 24 hours-2 weeks Physiological Breast feeding jaundice-Unconjugated bilirubin. May be exacerbated by dehydration. Sepsis-reduced fluid intake, haemolysis,impaired liver function & increased entrohepatic circulation Polycythaemia Metabolic disorders Liver enzyme defects Bruising Pathological Jaundice : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 13 Pathological Jaundice Presents <24 hours of life Rate of rise 8.5 umol/l per hour or (85 umol/l) per 24 hours Conjugated bilirubin >10% of Total Pathological Jaundice : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 14 Pathological Jaundice Is jaundice pathological? Is there an underlying disease process? Polycythaemia/ bruising Rhesus disease ABO incompatibility G6PD ( Glucose-6-phosphate dehydrogenase deficiency) Hereditary spherocytosis Congenital infection ( TORCH ) Rhesus Disease : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 15 Rhesus Disease This is a blood group incompatibility between the mother and newborn that can cause severe haemolytic anaemia in the fetus and newborn The Rh antibody is produced by a Rh negative mother after being exposed to a Rh antigen from fetal blood being blood Infants do not appear jaundiced at birth, but severe anaemia can lead to hydrops and death After birth, infants may develop hyperbilirubinemia rapidly ABO Incompatibility : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 16 ABO Incompatibility This is a haemolytic disease caused by a reaction of maternal anti-A or anti-B antibodies with fetal A or B antigens Almost exclusively in type O mothers Usually milder than Rh Jaundice appears at 24-72 hours Half of infants with a positive Coombs show haemolysis and some with a negative Coombs have haemolysis Complications : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 17 Complications Kernicterus( Neonatal bilirubin encephalopathy ) Management : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 18 Management Phototherapy Hydration Treat sepsis Immunoglobulin's Exchange transfusion Phototherapy : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 19 Phototherapy Blue Light- Neoblue Phototherapy units The main mechanism of action Photoisomerization of unconjugated bilirubin that can then be excreted without conjugation Hydration : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 20 Hydration There is no evidence that excessive fluid administration affects the serum bilirubin concentration Feeding inhibits enterohepatic circulation of bilirubin Important to watch fluid status for excretion of bilirubin Investigations : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 21 Investigations FBC/ Reticulocyte count-Haemolysis Blood group & DCT-Rhesus & ABO Urine for reducing substances-Galactosaemia U & E’s, LFT’s-Dehydration, Hepatitis, Liver disease Prolonged jaundice : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 22 Prolonged jaundice Unconjugated Breast milk Jaundice- 5-beta-pregnane-3-alpha-20 beta-diol Infection Hypothyroidism Galactosaemia Enzyme defects Conjugated ( Direct Bilirubin > 10% SBR) Biliary Atresia Enzyme defects Slide 23: 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 23 Prolonged jaundice : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 24 Prolonged jaundice Guidelines on Prolonged jaundice screen Conjugated or unconjugated hyperbiliruinemia Investigations: USS scan HIDA scan Liver biopsy You do not have the permission to view this presentation. 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Neonatal Jaundice samarsen Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 2853 Category: Science & Tech.. License: All Rights Reserved Like it (2) Dislike it (0) Added: May 13, 2010 This Presentation is Public Favorites: 3 Presentation Description No description available. Comments Posting comment... By: KOLLKHARAH (7 month(s) ago) PLEASE SEND IT TO ME Saving..... Post Reply Close Saving..... Edit Comment Close By: ajithanair005 (19 month(s) ago) nice presentation Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Neonatal Jaundice : Neonatal Jaundice Meena Sharma ANNP Objectives : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 2 Objectives Definition Production & metabolism of bilirubin Types of jaundice Management Neonatal Hyperbilirubinemia : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 3 Neonatal Hyperbilirubinemia Occurs in up to 60% of healthy term infants Yellow discolouration of skin, sclera & mucous membrane. Clinically evident when SBR reaches 80-100 umol/l Slide 4: 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 4 Bilirubin production & metabolism : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 5 Bilirubin production & metabolism Hb in neonate =18-19g/dl and in adult =11-14g/dl Breakdown of excess RBCs (Haemoglobin is a constituent of RBC) Hb broken into: globin - a protein that is conserved and utilised haem - cannot be used degraded and excreted Bilirubin is a product of this degradation It causes yellow staining of the tissues Bilirubin production & metabolism : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 6 Bilirubin production & metabolism The bilirubin first formed is UNCONJUGATED & FAT SOLUBLE. It cannot be excreted in bile or urine Unconjugated Bilirubin - travels in plasma, bound to albumin,can cross the blood brain barrier - enters the liver cells with the aid of Y & Z carrier proteins - becomes conjugated with glucoronic acid The reaction is catalysed by an enzyme Glucuronyl Transferase Bilirubin production & metabolism : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 7 Bilirubin production & metabolism Conjugated bilirubin is further catabolised by intestinal flora into: urobilinogen stercobilin It forms a major component of bile in faeces.(This gives the characteristic yellow colour to faeces.) A small amount is passed in the urine Enterohepatic circulation Slide 8: 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 8 Types of Jaundice : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 9 Types of Jaundice Physiological- 24 hrs-2 weeks old Pathological <24 hours old Prolonged jaundice- Term >2 weeks Preterm >3 weeks Physiological Jaundice : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 10 Physiological Jaundice Usually reaches its peak level at 2-5 days of age. Increased RBC’s Shortened RBC lifespan Immature hepatic uptake & conjugation Increased enterohepatic Circulation Physiological Factors Associated with Physiological Jaundice : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 11 Physiological Factors Associated with Physiological Jaundice Hb level is higher than required RBC have shorter life Hepatic Immaturity - reduced glucuronyl transferase activity - reduced active uptake of UB - reduced intracellular transport system - reduced active secretion of CB - large enterohepatic circulation of bilirubin to add to the load of UB in the hepatocyte 24 hours-2 weeks : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 12 24 hours-2 weeks Physiological Breast feeding jaundice-Unconjugated bilirubin. May be exacerbated by dehydration. Sepsis-reduced fluid intake, haemolysis,impaired liver function & increased entrohepatic circulation Polycythaemia Metabolic disorders Liver enzyme defects Bruising Pathological Jaundice : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 13 Pathological Jaundice Presents <24 hours of life Rate of rise 8.5 umol/l per hour or (85 umol/l) per 24 hours Conjugated bilirubin >10% of Total Pathological Jaundice : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 14 Pathological Jaundice Is jaundice pathological? Is there an underlying disease process? Polycythaemia/ bruising Rhesus disease ABO incompatibility G6PD ( Glucose-6-phosphate dehydrogenase deficiency) Hereditary spherocytosis Congenital infection ( TORCH ) Rhesus Disease : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 15 Rhesus Disease This is a blood group incompatibility between the mother and newborn that can cause severe haemolytic anaemia in the fetus and newborn The Rh antibody is produced by a Rh negative mother after being exposed to a Rh antigen from fetal blood being blood Infants do not appear jaundiced at birth, but severe anaemia can lead to hydrops and death After birth, infants may develop hyperbilirubinemia rapidly ABO Incompatibility : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 16 ABO Incompatibility This is a haemolytic disease caused by a reaction of maternal anti-A or anti-B antibodies with fetal A or B antigens Almost exclusively in type O mothers Usually milder than Rh Jaundice appears at 24-72 hours Half of infants with a positive Coombs show haemolysis and some with a negative Coombs have haemolysis Complications : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 17 Complications Kernicterus( Neonatal bilirubin encephalopathy ) Management : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 18 Management Phototherapy Hydration Treat sepsis Immunoglobulin's Exchange transfusion Phototherapy : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 19 Phototherapy Blue Light- Neoblue Phototherapy units The main mechanism of action Photoisomerization of unconjugated bilirubin that can then be excreted without conjugation Hydration : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 20 Hydration There is no evidence that excessive fluid administration affects the serum bilirubin concentration Feeding inhibits enterohepatic circulation of bilirubin Important to watch fluid status for excretion of bilirubin Investigations : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 21 Investigations FBC/ Reticulocyte count-Haemolysis Blood group & DCT-Rhesus & ABO Urine for reducing substances-Galactosaemia U & E’s, LFT’s-Dehydration, Hepatitis, Liver disease Prolonged jaundice : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 22 Prolonged jaundice Unconjugated Breast milk Jaundice- 5-beta-pregnane-3-alpha-20 beta-diol Infection Hypothyroidism Galactosaemia Enzyme defects Conjugated ( Direct Bilirubin > 10% SBR) Biliary Atresia Enzyme defects Slide 23: 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 23 Prolonged jaundice : 13/05/2010 Neonatal Jaundice/Meena Sharma ANNP 24 Prolonged jaundice Guidelines on Prolonged jaundice screen Conjugated or unconjugated hyperbiliruinemia Investigations: USS scan HIDA scan Liver biopsy